Ticket for Outdoor Patient
| Ward No. 0 | U-PHC No. | Registration No. 00429 | Date 23/11/2019 |
| Token No | SM/25-26/11072 27/11/2025 | Serial | 025 |
| Patient Name | Mrs. SHILA DEVI | Contact No | 8420337448 |
| Address | GHORAMARA P SERAMPORE 712203 | Age | 40 YRS Female |
| Token For | Visit Doctor, | Charge | Free |
| B.P | mmHg | Weight | KG |
| Pulse Rate | / min | Height | cm |
| Diagnosis | |||